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Home My WebLink About2795 PETERSON PL - Building PermitsCITY OF COSTA MESA BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.d.costa-mesa.ca.us FOR INSPECTIONS CALL: (774) 754-5626 PERMIT NUMBER. E08-00319 PERMIT TYPE ELEC APN: TPN007275 JOB ADDRESS: 2795 PE Vicinity: PUBLIC SIDEWALK SCOPE OF WORK: i00 AMP. REF: PS07-00873 ENCROACHMENT PERMIT "4220-F/G" AND REMOVE E STATUS: ISSUED DATE ISSUED: OS/0612008 -�- _,_,__ ISSUEDBY: YH "'t-'. c - ; � s . r ' . ' . ,...�� :.�� SON'PL CM'�. : '�. Suite/Unif:,;:�, Y . _ �R AT&T COMMUNICATION BOX. � � �,- �'�.� ' �+ �''. N SIDEWALK AND ASPHALT TO PLACE CONDUITS;'ABOVE GROUND CABWETS "ALP248C" AND BINET PER ATTACHED PLAN. 'et��-. � "' - - '.`i:'y. . ` �. "� ' �' : c _ —, ' _ _ .� . � �? i _ ' .. �. i - _ ' . ' . . .. , .��n ' " . ' . OWNER: CITYOFCOSTAMESA= � �f�- Address: �Umt � '•�` - ,� PHONE: �i}y 1 i'�s � - City/State/Zip: ' _ �� ; ',rt�• A4� �"i t -- ' . i.. �,�:"" . . - , . . APPLICANT: LIVONI, JAMES � � - � - ' � Address: � Unik , � � . . PHONE: 714 920b260 . - ' � ' City/State/zZip: " � CONTRACTOR: TAITENVIRONMENTALMANAGEMENT�INC �r Address: 701 NORTH PARKCENTER DRUniI: - "-� City/State: SANTA'ANA� CA ,l'_� ZipCode: 92705 ,.'ti:` ` �. . ''�� . - _ � ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0;00 , .. � , �'� License No.� PHONE: CELL: Electrical Permit Fee: ! '• $54.00 , Reinspection Fee $0.00 _: " TOTAL FEES . ' ' .$54.00,; _, - �. ; �,- -. . � . � - . ��. ,,� '. 588098 714-560$222 � i __ :�,:sc avo NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulatlons. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply vrith all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permil. CODEt. INSPECTIONTYPE �l IN7fML5 LOOEI INSPECTIONTYPE ORTE NITITULS 1616 Fized System Final Fire Prevention 206 Final Mechanical 1266 Pool SOa Final . 208 Final Plumbing �� 200 Final Re-Roof 210 Final Electnwl 201 Final BIocWReWining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �''_ 204 Final Demoli�ion 250 Final Builtling�Occupancy _ WORKERS' COMPENSATION DECLARATION: I hereby affrm under penalty of perjury one of the tollowing declarations: ❑ I have and will maintain a certifwte of consent to selt-Insure /or vrorkers' compensation, as Drovitle0 for by seclion 3700 of the Labor Code, for Ihe p�e/rfortnance of the vrork for which this pertnit is issued. �J +I have an0 will maintain v.orkers' compensalion insu2nce, as required by section 3700 of the Labor Code, lor the pertormance of the wnrk for which this permit is issued. My workers' compensation Insurance carrier antl policy number arye: Cartier: l��Z{Gf� MF.RI(. Y/ ��vf�[�lKIk.F �ri (IDis secfion need irot �e mmdetetl Atbe peimrt is valued al one bvnd�ed dollars (b100) oNessJ Policy Number: �.✓ �iy �� 1 �� jb I ❑ I certify Nat in the pertormance of lhe work (or which this permit is issued, I shall not employ any person in any manner so as to become subject to the woBers' compensalion laws of California, and agree [hat if I should become subject to the workers' compensation provisions of Section 3700 of Ne Labor Code. I shall foAhwith comply with lhese provisions. �i.... A `-�.�=� SS-/<�r � Appliwnh Slgnature Date WARNING: FAIIURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAAMGES AS PROVIDED FOR IN SECTION 3706 OF THE LP.BOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm ihat I am licensed under provisions of Chap[er 9(commencing vnlh Section 7000) of Division 3 of lhe Business and Pro(essions Code. and my licenLs-e Uis�in full force and eRecl. Lic. # 7 n X(�/G `� Class #/. ICI ri/� A51i �1�-- lr%�t'(hT �� Conracl0r'sSiBnaWre Date Owner ID verified by driver's lice ❑ Yes ❑ No Driver's License No. Expires: Veri(calion of Ownership by (type ot documenl, i.e. - property lax bill or tleetl): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: � ❑ I hereby certify that no excavation five (5) or more feet in depth into wfiich a person is requiretl to tlescend, will be made in connection vrith work autFrorized by this pertnit, and that no building sWcture, scaHdding, falsework, or demolilion or dismantling thereof, will be more than thirty-six (36) fee[ high. (Chap. 32. Gry 2, Art 2, Sec. 341, Ttle 8, Calitomia Adminis[rative Code). ❑ As Owner-builder, I will not employ anyone to tlo work which woultl require a permit from the Division of Industrial Safety, as notetl above, unless such person has a permit lo do such vrork from the division. ApPliwnl's SignaWre Dale Division of IndusMal Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicaM or present or (uWre building occupant need to file antl certify a Business Plan for emergency response to release or ihreatenetl release of a hazardous malenal? ❑ Yes ❑ No (Section 25505 of the Cali(omia Health and Sa(ery Code requires. with some exceptions, Ihat a Business Plan be filed with the Costa Mesa Fire Departmenl by every business which has a[ any one time tluring a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at stantlartl temperature and pressure). 2. Does or will the applicant or present or fu[ure builtling occupant need to file a regisUation form for acutety hazardous materials? ❑ Yes ❑ No }{pZ (Section 25533 ot the Califomia Health antl Safery Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one [ime has on hand a quantity of acutely hazardous matenals equal to or greater than a weight of 500 pounds, or a volume ol 55 gallons, or 200 cubic feet o� compressed gas at stantlartl CONS7RUCTION LENDING AGENCY: temperature and pressure). � I hereby aKrm that there is a constructbn lentling agency for lhe pertortnance of Ihe Nork for wfiich this pertnit is issued. (Sec. 3097. Civil Code). Lender s Name: Lender'S Atldress: SignaWre Dale OWNER-BUILDER DECLARATIONS: I hereby aHirtn that under penalty of perjury [hal I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe (ollowing reason (Sec. 7031.5, Business ana Professions Code: Any ciry or wunry which requires a pertni� to construct, aller, improve, demolish, or repair any structure, prior lo its issuance, also requires the applicant for such permit to file a signed statement lhal he or she is licensed pursuaN lo lhe provisions o( the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business anC Professions Code) or that he or she is exempt there(rom and Ihe basis for the alleged exemption. Any violation of Sec[ion 7031.5 by any applicant for a permit subjecls Ihe applicant lo a civil penalty of not more Ihan five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contrectors License Law does not apply to an owner of property who builds or improves Ihereon, and who does such vrork himself or herself or through his or her own employees, provitled that such improvements are not intended or ofteretl for sale. If, however, ihe building or improvement is sold within one year of completion, the owner-builder vrill have the burden of proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to consWct the project (Sec. 7044. Business and Pmfessbns Cotle: The contractors License Law tices nol appy to an ovmer o( property wtio builtls or improves Ihereon, and who contracts for such project wit� a contract«(s) license pursuant ro the Contractors License Laws.�. ❑ I am exempt under sec. Business and Professions Cotle for this reason: ]09A6(]RI]� 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevenlion Program (or acutely hazardous materials)? ❑ Yes ❑ No (Seclion 25534 of the Cali(ornia Health and Safery Cotle provides Ihat Ihe Cosla Mesa Fire Department may require the preparation, cenifcation and filing with lhe Fire Department of an RMPP by businesses which are requiretl to register awtely hazardous materials with [he Fire Departmenl. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complietl wilh? ❑ Yes ❑ No 5. Does or will the applicant or present or future builtling occupant require !or the work which is the sublect of this applicatlon a permit for such construclion or moCification from the South Coast Air Quality Manaqement DisMcl or from any other air pollution control tlistrict or agencyl ❑ Yes ❑ No (Section 658502 of ihe Califomia Govemment Cotle requires that the requested infortnation be fumishetl on applications fa ran-resitlential builtling pertnits). 6. Will any part of the faciliry to be constructed unCer ihis permit be within 1000 feet from lhe outer boundaries of a school? ❑ Yes ❑ No (If'yes", Ihe (acilily musl meet Ihe requirement of Sections 25594 antl 42303 of the Calitornia Health and Safe[y Code). 7. If a permit from the South Coast Air Quality Management Dislrict or olher air pollution control district or agency is requiretl for the work which is ihe subject of this application, have all of the disclosures prescnbed by Califomia Health and Safery Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate of compliance from the appropriate air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify that untler penalry ol peryury the information qiven above is correct. I agree to�comply with all stale laws antl cily ordinances regarding Hazardous Materials and Emissions. • Sip�uWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenify under penalry of perjury that I have read Ihis application and state that the intormalion given is covecL I agree to comply with all state lavrs and cily ortlinances relating to building construction, antl authorize represeNatives of the City of Costa Mesa to enter upon Ne abovedescnbed property for inspection purposes. I agree not to occupy or allow occupancy of any builtling authorized by Ihis pertnit until fnal inspection. ,^/ Signawre ot Legai Owner(s) /� Oaie Ji.w_ U � (J �� irY MO/OrAut�miCEAppliranl- pa1G